- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,830.07 / $2,014.83 / $2,966.81
| Professional | | $1,830.07 | $2,014.83 | $2,966.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,948.84 / $2,114.67 / $2,417.08
| Professional | | $1,948.84 | $2,114.67 | $2,417.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,535.92 / $1,991.24 / $4,128.43
| Professional | | $1,535.92 | $1,991.24 | $4,128.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,678.78 / $2,165.63 / $3,590.47
| Professional | | $1,678.78 | $2,165.63 | $3,590.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.50 / $1,841.07 / $3,321.84
| Professional | | $1,413.50 | $1,841.07 | $3,321.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.87 / $1,312.87 / $2,355.26
| Professional | | $1,312.87 | $1,312.87 | $2,355.26 |